Lifestyle Medicine Programmes for Children and Young People in Residential Care

“At Edison Young People, we are responsible for looking after CYP who have come from difficult environments and have been placed in residential care.”

The term ‘looked after’ was introduced by the Department of Health (1989) and is used in the United Kingdom to describe all children in the care of the local authority. ¹ These children and young people (CYP) may be in public care voluntarily or may be subject to care orders by the Courts which grant the local authority shared parental responsibility. ² There are a number of settings where CYP may be ‘looked after’, including in residential homes or schools, along with secure units and foster placements.^2,3

At Edison Young People, we are responsible for looking after CYP who have come from difficult environments and have been placed in residential care. Our aim as a company is to improve the opportunities and outcomes for the CYP we look after, so they are able to live fulfilled and useful lives. Our CYP can present as complex individuals, who may have been placed in the care of the local authority for a number of different reasons, including physical, emotional and/or sexual abuse. They also may have been subject to various forms of neglect or been in circumstances which resulted in their parents not being able to provide adequate care. ² Due to their early experiences, our young people can present with a variety of different behaviours and conditions. Research has shown that mental and physical health difficulties tend to be higher in looked after children and young people when compared with the general population. ⁴ Moreover, it has been estimated that 10% of children (aged between 5–10 years) in the general population suffer from mental health disorders, compared with 70% of CYP who are looked after in a residential care setting. ⁴ This is not surprising given that childhood malnutrition and maltreatment are both associated with mental health difficulties, as they can lead to altered growth and development, which consequently can result in neurological, behavioural and cognitive difficulties. ⁵

In recent years, research has indicated that chronic diseases are becoming increasingly prevalent in the adolescence population. ⁶ Many high school students fail to obtain adequate sleep, with 10% reporting less than 6 hours each weeknight. ⁷ Moreover, shorter sleep durations have been linked to obesity in adolescence and poorer academic performance due to increased difficulty with paying attention and increased stress levels. ⁷ In addition to this, studies have shown that in most western countries, children and adolescence eat less than the daily recommended amount of fruit and vegetables, ⁸ which is problematic as high fruit and vegetable intake has been shown to promote health and prevent chronic disease. ⁹ This has highlighted the need for lifestyle medicine education to help confront the growing problem of unhealthy lifestyles within younger generations. Targeting children and young adults is essential as studies have demonstrated eating and lifestyle habits established in early adolescence tend to continue into adulthood. ⁹ A recent pilot programme was carried out at a private middle school in Boston, where students learned the importance of proper sleeping habits and how this linked to improved cognitive function. They also learned how to use sleep as a tool for boosting performance in the classroom. ⁶ In addition to this, they also found that when students were provided with evidenced based approaches to health lifestyles, they we able to better understand the power and importance of lifestyle medicine. ⁶

As epidemiological studies have demonstrated that early childhood maltreatment can have an impact on health and emotional wellbeing, ¹⁰ combined with the large body of research highlighting the importance of early lifestyle medicine intervention, we at Edison Young People are launching a lifestyle medicine programme across some of our residential homes, in the hope to assist our CYP in developing healthy daily habits to improve their short-term and long-term health, along with increasing their quality of life. The program is overseen by Dr Beth Frates and Clinical Lead Stelios Kiosses and run by our assistant psychologist Abbie Garrett who is also responsible for introducing lifestyle medicine to our CYP and the care staff working with the CYP. The program was initially created and developed with the guidance and assistance of Dr Beth Frates (Diplomate of ABLM and Fellow of ACLM). The programme consists of 12 sessions which encompasses the main six pillars of lifestyle medicine, including healthy eating, regular physical activity, stress resilience and management, sleep, avoiding hazardous substances and relationships. Each session combines teaching elements, with fun activities and applies the principles of coaching, along with motivational interviewing to help our young people make positive changes surrounding their lifestyle. A variety of resources from the American College of Lifestyle Medicine (ACLM) were utilised when developing the 12 sessions, including information and activities from the Teen Lifestyle Medicine Handbook, ¹¹ along with PowerPoint slides from the Teen Curriculum. If you would like to access these slides for the development of your own programme, The Teen Lifestyle Curriculum can be downloaded through the American College of Lifestyle Medicine’s website, and anyone can become a member of the Paediatric interest group. As some of our CYP can be resistant to engage when they perceive tasks to be too ‘educational’, rather than show the slides from the Teen Curriculum, the information was lifted and presented to them as a discussion whilst carrying out activities. A person-centred approach will be taken for the 12 sessions and therefore the plan is to be adapted to suit the young person and their area of difficulty (e.g. if they struggle with their diet, sleep or stress resilience). Throughout the programme, our CYP’s emotional wellbeing will be monitored through different questionnaires, to allow us to track any changes. Below is an outline of some of the possible sessions, along with the learning objectives and outcomes.

12 Sessions of Lifestyle Medicine

Session Number	Session Topic	Learning Objectives and Outcomes
1	Introduction session	Experiential cooking or baking activity to introduce CYP to the concept of lifestyle medicine and what to expect
2	Food for fuel, performance and mood	To understand how what we eat effects our brain and organs
		To understand how sugar fits into our diets and daily recommended amounts
		To understand the effects sugar has on health
		Learn about reducing sugar consumption and sugar swaps
		To practice applying knowledge of sugar swaps to recipes and cooking
		Set SMART goals to reduce sugar intake
3	Eating for energy	To review and evaluate SMART goals from the previous session
		To identify the different food groups
		To understand the key aspects of a well-balanced, healthy diet and proportions needed of each food group to maintain this
		To create/paint own eat well plate
		To understand the role the food groups, play in health
		To be able to apply knowledge of a health balanced diet to plan a meal
4	Eating for energy continued	Go over the nutrition health link in more detail – Understand the effect a bad diet can have on health and correct portion sizes
		To understand what hyperpalatable foods are
		To be able to apply knowledge of the eat well plate to prepare a meal
5	Whole food plant-based diet – Veggie alternatives	To learn about whole food plant-based diets/vegetarian diets
		To understand different types of protein (those from plants and meats)
		To understand why some people may choose to eat a vegetarian diet
		How we can cut down on meat consumption – discussion surrounding alternatives
		Cooking activity – Swapping meat-based favourite for a fun vegetarian meal
6	Moving for fun and focus	To review the definitions of physical activity and be aware of the physical activity recommended guidelines
		To understand the health benefits of physical exercise on the body and the brain (including focus and energy)
		To get involved/try a new activity
		Understand different elements of fitness and ways we can measure this
		Set SMART goals related to physical activity
7	The importance of sleep	Learn why sleep is important and understand the impact it has on our brain and bodies
		To become aware of own sleeping patterns and sleep hygiene
		To be able to discuss own sleep patterns
		Create a dream catcher/Discuss how to make a calm space
		To be able to keep a sleep journal to track sleeping patterns
8	Stress and resilience	Review and evaluate sleep journal from the previous week
		To have a basic understanding of what stress is and what it may feel like
		To understand situations that might cause some people to become stressed
		Learn preventative measures to cope with stress
		To create a calm kit to help manage own stress
		Learn how to use ‘My Personal Stress Plan’
9	Meditation, mindfulness and relaxation	Review objectives from the previous week
		To understand what meditation, mindfulness and relaxation is
		To learn the health benefits of practicing peace of mind
		To learn some breathing, meditation, relaxation and mindfulness techniques
10	The power of connection and understanding emotions	To understand why social connection is important for our health
		To learn barriers for social connection
		Building interpersonal skills through fun activities and games (learning about compliments)
		Activities surrounding understanding own emotions coping behavioural techniques – to allow YP to manage their own emotions
11	Understanding and avoiding hazardous substances/social media addiction	To understand the impact of substance use of physical, mental and behavioural health and wellness
		To learn different skills and techniques to avoid harmful substances
		To learn about gratitude
		Strengthening self-respect and building resilience (activities surrounding this)
12	Superpowers	Review and recap across sessions
		YP to identify own strengths and find ways for them to use these
		Goals for the future identified
		Sugar free cake baking activity to share with peers

As mentioned previously, the information provided to the young person is done by a discussion whilst carrying out activities, rather than a presentation and slides. For example, for the session, ‘Food for fuel, performance, and mood’ whilst carrying out a sugar free baking activity, the discussion should include how food acts as a fuel for our bodies, about different nutrients and sugar intake. It is important for our young people to understand their daily recommended amounts and how much sugar is in some of their favourite snacks. Coaching and working with our young people will be important, so they are able to make their own choice and change their own habits. The coaching/educational sessions have been completed with a number of young people already and it has assisted them in thinking about their own sugar intake and diet. For example, one young person discussed the effects of too much sugar consumption on our physical and mental health, whilst working together on a sugar free baking activity. They then played a sugar guessing game, where the YP had to guess the amount of sugar in some common snacks, including Ice cream and chocolate. The YP was surprised by the amount and made the link to her daily recommended amount. She then set SMART goals to try to reduce her daily snack intake, she shared that she wanted to try and stick to one chocolate snack a day, rather than multiple. When asked why she was wanting to make this change, she stated it was for her health and she wanted to reduce her risk of diabetes and other related health conditions.

This programme we believe has the potential to improve the mental health and wellbeing, along with increased healthy habits in children and young people in a residential care setting. This population may not have had adequate role models within early life to help them form healthy habits. Furthermore, the research literature has indicated that this population is more susceptible to mental and physical health issues; therefore, it is extremely important to encourage our CYP to develop and maintain healthy habits and life skills to better their physical and mental wellbeing. Although more methodological work is needed on how to robustly capture the impact and outcomes of lifestyle medicine in residential settings, we believe here at Edison Young People that we have already started making a positive impact on our young people by implementing the principles and practices of lifestyle medicine.